Importance of Potassium in Cardiovascular Disease

Sica, Domenic A.; Struthers, Allan D.; Cushman, William C.; Wood, Mark A.; Banas, John S.; Epstein, Murray

doi:10.1111/j.1524-6175.2002.01728.x

Cited by 78 publications

(50 citation statements)

References 58 publications

(53 reference statements)

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“…During the development of atherosclerosis, potassium may regulate multiple cellular processes, as it can affect VSMC proliferation (37), or interplay with sodium homeostasis and a number of neurohormonal pathways that regulate blood pressure (54). Our findings highlight the importance of dietary potassium-regulated VSMC calcification in atherosclerosis.…”

Section: Discussionmentioning

confidence: 81%

Dietary potassium regulates vascular calcification and arterial stiffness

Sun¹,

Byon²,

Yang³

et al. 2017

JCI Insight

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Section: Discussionmentioning

confidence: 81%

Dietary potassium regulates vascular calcification and arterial stiffness

Sun¹,

Byon²,

Yang³

et al. 2017

JCI Insight

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“…8 Collectively, these findings suggest a link between systemic potassium homeostasis and atherosclerosis and thrombosis. 9,10 We note, however, that potassium is primarily an intracellular ion, so that dietary intake and diuretic use are likely to have an effect on intracellular potassium pool even without detectable changes in serum potassium.…”

mentioning

confidence: 99%

Potassium Chloride Supplementation Diminishes Platelet Reactivity in Humans

Kimura¹,

Xiao-bin²,

Skurnick³

et al. 2004

Hypertension

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Abstract-The prevalence of occlusive stroke is inversely correlated with potassium intake. We explored the hypothesis that a high potassium intake attenuates platelet reactivity, as expressed in ADP-evoked platelet aggregation. We studied healthy men (nϭ31) and women (nϭ42), blacks (nϭ33) and whites (nϭ40). In this cohort, we supplemented the habitual intake of 17 men and 21 women with 60 mmol KCl/70 kg body weight per day for 3 days and maintained 14 men and 21 women on their habitual intake. We then compared the change in ADP concentration causing 50% of the maximal initial rate (EC 50 ) of platelet aggregation in the potassium-supplemented versus control groups. Potassium supplementation attenuated platelet reactivity, expressed by an increase in EC 50 of platelet aggregation (Pϭ0.0005), which was primarily attributable to an increase in EC 50 in whites (Pϭ0.0004). Urinary potassium excretion was significantly lower in blacks than in whites under basal conditions and after potassium supplementation. We conclude that potassium supplementation diminishes platelet reactivity, a phenomenon that provides a link between platelet biology and occlusive stroke. Key Words: stroke Ⅲ cardiovascular disease Ⅲ atherosclerosis T he potential cardiovascular benefits of dietary potassium in the general population have been considered primarily from the perspectives that potassium may serve as a sodium substitute in the diet and that a high potassium intake enhances natriuresis. 1 Accordingly, the beneficial effect of a high dietary potassium intake on the cardiovascular system would presumably be mediated by the concomitant reduction in dietary sodium intake, coupled with enhanced sodium excretion, as well as other mechanisms that may ultimately lower blood pressure. 2 The question that follows is whether or not the cardiovascular effect of a high potassium intake may also be mediated through blood pressure-independent mechanisms, given that large-scale studies strongly suggest that dietary potassium intake is inversely correlated with occlusive stroke, a relationship that is independent of the effect of potassium intake on blood pressure. [3][4][5][6][7] Further, in the Systolic Hypertension in the Elderly Program (SHEP) within the treatment group, the risk for cardiovascular events, including stroke and myocardial infarction, was significantly higher in subjects with hypokalemia (serum potassium Ͻ3.5 mmol/L) associated with diuretic use. 8 Collectively, these findings suggest a link between systemic potassium homeostasis and atherosclerosis and thrombosis. 9,10 We note, however, that potassium is primarily an intracellular ion, so that dietary intake and diuretic use are likely to have an effect on intracellular potassium pool even without detectable changes in serum potassium.Because thromboembolic processes largely depend on platelet biology, we hypothesized that a high potassium intake would diminish platelet reactivity. This concept was explored in the present work. Materials and Methods SubjectsWe studied healthy men (...

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“…The hazards central to diuretic-related hypokalemia are most apparent in patients with left ventricular hypertrophy, HF, and/or myocardial ischemia, particularly when they become acutely ill and have need of hospitalization [ 95 ]. As mentioned previously, outpatient forms of diuretic-related hypokalemia are seldom of a severe enough nature to demand urgent attention; however, these mildly lowered serum K + values create a basis for more signifi cant degrees of hypokalemia when transcellular shifts of K + are interposed, as occurs during stressful circumstances marked by high endogenous epinephrine levels [ 94 ]; therein lies one of the major at-risk scenarios of diuretic-related hypokalemia.…”

Section: Hypokalemia/hyperkalemiamentioning

confidence: 97%

“…However, it is unusual for serum K + values to settle <3.0 mmol/L in diuretic-treated outpatients, apart from a high dietary Na + intake, and/or when a long-acting diuretic is being given, as is the case with chlorthalidone. Mechanisms that contribute to the development of hypokalemia during diuretic use include increased fl ow-dependent distal nephron K + secretion (more commonly observed with a high-Na + intake), a fall in distal tubule luminal chloride, metabolic alkalosis, and/or secondary hyperaldosteronism [ 94 ].…”

Section: Hypokalemia/hyperkalemiamentioning

confidence: 99%

Diuretics for the Treatment of Hypertension

Sica

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Diuretics are agents commonly used in diseases characterized by excess extracellular fl uid, including chronic kidney disease, nephrotic syndrome, cirrhosis, and heart failure. Diuretics are also commonly used either as monotherapy or in combination with other antihypertensive agents in the management of hypertension. Multiple diuretic classes, including thiazide-type diuretics, loop diuretics, and potassium-sparing diuretics, are used to treat patients with these diseases. An understanding of what determines a patient's response to a diuretic is a prerequisite to the correct use of these drugs. The response of patients with these diseases to diuretics, which is related to the dose, is best described by a sigmoid curve whose contour can become distorted by any of the several sodium-retaining states that are directly or indirectly associated with renal disease. The pharmacodynamic effect of diuretics as used in the treatment of hypertension involves both a volume removal element and more long-term vasodilation. Diuretic actions are of considerable importance to patients who have renal disease, as their effective use assists in extracellular fl uid volume control, reducing excretion of protein in urine and lessening the risk of developing hyperkalemia. Diuretic-related adverse events that involve the uric acid, sodium, and potassium axes are not uncommon; therefore, the clinician must be vigilant in looking for biochemical disturbances. As a result of diuretic-related adverse events, clinicians must be resourceful in the dose amount and frequency of dosing.

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Importance of Potassium in Cardiovascular Disease

Cited by 78 publications

References 58 publications

Dietary potassium regulates vascular calcification and arterial stiffness

Dietary potassium regulates vascular calcification and arterial stiffness

Potassium Chloride Supplementation Diminishes Platelet Reactivity in Humans

Diuretics for the Treatment of Hypertension

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